Opportunistic Infection Associated With Elevated GM-CSF Autoantibodies: A Case Series and Review of the Literature

Elinor Lee; Christopher Miller; Ali Ataya; Tisha Wang

doi:10.1093/ofid/ofac146

Opportunistic Infection Associated With Elevated GM-CSF Autoantibodies: A Case Series and Review of the Literature

Open Forum Infect Dis. 2022 Apr 9;9(5):ofac146. doi: 10.1093/ofid/ofac146. eCollection 2022 May.

Authors

Elinor Lee¹, Christopher Miller¹, Ali Ataya², Tisha Wang¹

Affiliations

¹ UCLA Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
² Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA.

Abstract

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is known to play a key role in enhancing multiple immune functions that affect response to infectious pathogens including antigen presentation, complement- and antibody-mediated phagocytosis, microbicidal activity, and neutrophil chemotaxis. Reduced GM-CSF activity and immune response provides a mechanism for increased infection risk associated with autoimmune pulmonary alveolar proteinosis (aPAP) and other disorders involving the presence of GM-CSF autoantibodies. We present a case series of five patients with persistent or unusual pulmonary and central nervous system opportunistic infections (Cryptococcus gattii, Flavobacterium, Nocardia) and elevated GM-CSF autoantibody levels, as well as 27 cases identified on systematic review of the literature.

Keywords: autoantibodies; autoimmune pulmonary alveolar proteinosis; granulocyte-macrophage colony-stimulating factor; infection; sargramostim.

Publication types

Case Reports